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PRE 2010 DOCSSUBJECT PERMIT City of Fridley ® 4536 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIP ' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �� 1 I 1 -'S CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �'--'A f .J 612-560-3450 910-F15 12/30/77 l � JOB ADDRESS 5605 West Bavarian Pass N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4 22 Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darrel A. Farr Development Corp. 7286 - 72nd Lane No. 560-8110 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 11 ADDITION El ALTERATION El REPAIR El MOVE El REMOVE % 8 DESCRIBE WORK Construct a 271 x291 Townhouse and a 211 x 221 Garage Matterhorn 9 CHANGE QF USE FROM TO STIPULATIONS t9 TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 796+462 20,200 Total ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $25,795 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S80.80 PLAN CHECK FEE TOTAL FEE SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN P OP LY VALIDATED THIS IS YOUqr PER IT SIGNATURE OF OWNER (IF OWNER BUILDER( (DATE)BLDG INSP Z CDATE APPLICATION FOIt R1.:Sll)liNTJA1,, A1.' EIZA'I'IU.',1, Olt ADI) TJOIN BU11.1)ING 1'1:RIMIT CITY Ul'-* F1'ZJlJ1.1:Y, 0:•i:;L•'R'S I\��i);:�Jdi�d". ��db�- Ol&"t�. [��r�{BUILllFR:_ �it�� f.DMR ET Ss : ��► � � ��� � �•ADD11:ESs LOT: BLOCK: ADDITIO.: C01d, ER LOT: INS IDE LOT: SETBACK:' SI DEY'E'+RD : Applicant attach to this form Tcao Certificates of SurveX of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING 01�tf��J60 To .Be Used As: 1�9e�/.rlhaMSe- Front: Depth: ' Height: 20 Square Feet: ®�1.- Cubic Feet: SZP GQb-a a e, Front: Depth: J22.Height: /0 Square Feet; -46.2 Cubic Feet: 4 Type of Construction: ®og Frame, Estimated Cost:_ $ Q�!6 0®® _. To Be Completed: 19 76 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stiict •accordance with the City, of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts aAd representations stated in this application are true and correct. DATE: SIGNATURE : (See Reverse Side For Additional Information.) MECHANICAL HARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $ L,2, 6) each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to SS00.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STEk.II OR POT WATER SYST-1: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures X S 3.00 Additional Fixtures X $ 1.00 Gas Range to 199,000 BTU X $10.00 AIR CONDITIONING��?7�<%'� FAN HEATING SYSTEMS � See Fee Schedule , VENTILATING SYSTEMS ALTERATIONS F REPAIRS • State Surcharge TOTAL FEE SOUGH INSP. rate rINAL INSP. Date APPROVAL FOR FEP-4IT REINSPECTION FEE 010.00) S F S S .50 MINIMUM FEE FOR ANY HEATING PERMIT IS $7. SO PLUS $.SO STATE SURCHARGE The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes •. and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. - , 19 OWNER .?� _f �C� r. -i f ;r _-- — -- -- KIND OF BUILDING USED AS �,� jJe- TO BE COMPLETED ABOUT > P 7-� ESTIMATED COST OLD - NEW BUILDING PER141T NO. PERMIT NO.- DESCRIPTION O. DESCRIPTION OF FURNACE/BURNER HEATING.or POWER PLANTS, Steam, Hot Water, Warm Air -`,No. 9 Trade Name ;1 �, ��F �`, Size No. 6 Capacity Sq. Ft. EDR BTUHP Total Connected Loady� 2 ;= Kind of Fuel �V1. BURNER - Trade Name' Size No. Capacity Sq. Ft. EDR BTU HP CompangEO° SEDGWICK H G. & AIR COI D. CO. Signed By n _'✓i:.ti �' d1' c • Tel. No. ftft1 0 X11 � �" :',-' � � ^e .•,'.� _. � ;;. _ APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address 0-0C i r\y,-' S Furnace Shell & Duct Work ' $12.00 $ Replacerent of Furnace Repairs &Alterations -up to $500.00 7.00 7.00 $ $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley dle y Tel. #571-i450 MECHANICAL HARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $ L,2, 6) each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to SS00.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STEk.II OR POT WATER SYST-1: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures X S 3.00 Additional Fixtures X $ 1.00 Gas Range to 199,000 BTU X $10.00 AIR CONDITIONING��?7�<%'� FAN HEATING SYSTEMS � See Fee Schedule , VENTILATING SYSTEMS ALTERATIONS F REPAIRS • State Surcharge TOTAL FEE SOUGH INSP. rate rINAL INSP. Date APPROVAL FOR FEP-4IT REINSPECTION FEE 010.00) S F S S .50 MINIMUM FEE FOR ANY HEATING PERMIT IS $7. SO PLUS $.SO STATE SURCHARGE The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes •. and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. - , 19 OWNER .?� _f �C� r. -i f ;r _-- — -- -- KIND OF BUILDING USED AS �,� jJe- TO BE COMPLETED ABOUT > P 7-� ESTIMATED COST OLD - NEW BUILDING PER141T NO. PERMIT NO.- DESCRIPTION O. DESCRIPTION OF FURNACE/BURNER HEATING.or POWER PLANTS, Steam, Hot Water, Warm Air -`,No. 9 Trade Name ;1 �, ��F �`, Size No. 6 Capacity Sq. Ft. EDR BTUHP Total Connected Loady� 2 ;= Kind of Fuel �V1. BURNER - Trade Name' Size No. Capacity Sq. Ft. EDR BTU HP CompangEO° SEDGWICK H G. & AIR COI D. CO. Signed By n _'✓i:.ti �' d1' c • Tel. No. ftft1 0 X11 � �" :',-' � � ^e .•,'.� _. � ;;. _ Z3 So, b HEAT'LOSS CALCULATIONS H IE A TI M G P-,- A2, E R- n_ rf n P, 7D nva P, q. a P r-- (,- e j'IAlM\f;:IAPnl 1� k4INNI Weatherstrips A. S. H. V. E. Construction No. Insu, lation Windows Doors Guide Out. Wall Int. Wall Ceiling Roof I f1c, How Applied Reference Floor 10'r T Yes --NO Ye,—No 19— e.�_ Length Fl. f Room Width eight Length -2-"7 Width if(, Height Windows and Doors—Cracksge and Area nd --Crackage and Area VVindows No, Width H No. of Lineal ft, Area of lights Of Crack sq. ft. N". i W,dth N". CA Area f pane I of phoe Of crack sq. N. o ell -!z,gid G, F 4 r CoefjBtu Foef Btu InfiltrationIN Infiltration? v7 Glass J Glass Exp. wall-, Exp. wa f 1 0 Net exp. wa I I P. Net exp. wall 7 Int. wall Int. wall Ceiling Ceiling FloorFloor Total Btu. Total Btu, Req . uired sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins, W.A. Leader area 'FI. Room I Length Width HeightRoolm I Length We. htf jf� W . indows and Doors—Crackage and Area L Doors —Crackage and Area I H g mom ft. Aces N,. can,- o f 1P, �A n t! I iq! T S of crack sq. ft. No. Width Height of pane pane of a No. of Lineal ft. lights I of crack Area sq. ft. 3 x 5oe fj Btu CeTf B to Infiltration I nf i I tra t i or. Exp. wal I w-111 Glass 4v Exp. wall Net exp, wall Int. wall L Ceiling (-'e: j; .,• -! - =C_5 Floor Total Btu. Required sq, ft. E,D.R, or sq. ins. W.A. Lea Leader area Re,;,,:red s,4. f! �.D,R, or N,A. t. adpr area I Width 1Z I Height45 WF Length Width He,Qht Windows and Doors--Crackage and Areji V,'indow,, anti -Cfackage. and Area W, dth He.g�lt No OIT7­1 , - 7No. Of p I H Of pOn© 11g?I!S t �,� *Area t, r- of crac'�< :� a. f T. _4 --- -------------- T_. Coef! Btu ic"oef Btu lnf i Itration Glass Exp' wall Exp. 'w;all Net exp. wall l"I. wall Net exp. wall—___-- Int. waIJ �Ceiling Xt P -bol ....... ........ Total Btu., Floor Total Stu. red sq: f t; E.-D.R.- or sq. tris, VV.A_ fader -Recju erred sq. f -:.:E DJ2., or, ��q. ins. W.A. Leader -area CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. X x FAA $3.00 $2.00 $2.00 $5.00 $5.00 $10.00 $7.00 $5.00 $5.00 x Ix $1.00 x $10.00 State Surcharge REINSPECTION FEE ($10.00) TOTAL S S $5.00 $ $2.00 $ $ .50 s� . Job Address , �G � , `CL' i'6 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and Correct Fridley, Mn. _ / 5 , 19;7.P OWNER KIND OF BUILDDING USED AS Py Lt) f TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company 7\�e'-111- N/ Signed By Tel. No.Z// ROUGH INSP. Date FINAL INSP. I - .I Date APPROVAL FOR PERMIT F� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLU9 $.50 STATE SMMMM 0 Water m 49 m � m H i ro � w O W s4 m44 pa, � � Heater M 9l m t d W� .0 q 3 4 g:g O U 4, p O .5 R N .4 O O S 49 N 43 W up1 W to U D O% �W�yy 00 tom!! 3 O N t�A W U M 3 (7 mN c7 O as lec 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (+) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. X x FAA $3.00 $2.00 $2.00 $5.00 $5.00 $10.00 $7.00 $5.00 $5.00 x Ix $1.00 x $10.00 State Surcharge REINSPECTION FEE ($10.00) TOTAL S S $5.00 $ $2.00 $ $ .50 s� . Job Address , �G � , `CL' i'6 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and Correct Fridley, Mn. _ / 5 , 19;7.P OWNER KIND OF BUILDDING USED AS Py Lt) f TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company 7\�e'-111- N/ Signed By Tel. No.Z// ROUGH INSP. Date FINAL INSP. I - .I Date APPROVAL FOR PERMIT F� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLU9 $.50 STATE SMMMM 97-85-51$®51 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures X $3.00 Future Fixture Opening x $2.00 ?. In $2.00 v Catch Basin x m Water Heater - to 99,000 STU Water $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x ►i � en q W rd$4 W w ) Heater O , x a ti m 0�tl�ppf •H .0 O 6. 11 N G PD 11 N a �y{ N �tlyJ a3 leC to U O tG Ri V1 .4 0 w to C7 t9 O 1st ra 2nd 3rd 4 th (R) = Future Connection Opening Connected with Sewer (') m New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures X $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening X $2.00 Catch Basin x $5.00 Water Heater - to 99,000 STU X $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x $7.00 New Ground Run Old Building X $5.00 Electric Water Heater X $5.00 GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x '$3.00 X $1.00 X $10.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) $5.00 $2.00 S Job Address 5605 West Bavarian *Pass Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work hereie specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 8-8-78 , 19 OWNER DARRELL FARR KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 8-15-78 ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. 1 . Company p Signed By Tel. No. ROUGH INSP. Date . e' FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT I3 $7.50 PLUS $.50 STATE SURC4SL= r SWIff August 18, 1978 CITY OF F I LE`S 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Darrel A. Farr Development 7286 - 72nd Lane North Minneapolis, MN 55428 Re: Final Inspection at 5605 West Bavarian Pass N.E. Dear Sirs: A final inspection was made on August 17, 1978 of the above address and the following items were noted which must be completed before the structure. can be finaled out; 1. Extend hearth to 18 inches minimum from face (it is now 9 inches) by. August 24, 1978. 2. Repair or connect smoke detectors by August 24, 1978. 3. Complete plumbing final by August 24, 1978. 4. Lower grade to expose 6 i.nches of block work by August 24, 1978. We will expect the above items to be completed on or before the scheduled date when a reinspection will be. made to determine compliance. If you have any questions on these items, please contact me at 571-3450. Sincer RON HOLDEN Building Inspector RH/mh r' Mr. John Flora City of Fridley 6431 University Ave. NE Fridley, MN 55432 Dear Mr. Flora: July 6, 1995 This note is to follow up on the telephone conversation we had on Friday, June 30, 1995 regarding our sump pump problem. We have had contact with one of our neighbors who just completed his diversion and my husband is meeting with him today to see how this was accomplished - he also stated on the telephone he could recommend someone who could do this work at a reasonable price. You requested I give you some idea of when the work will be com- pleted and I believe we should have the job finished by the end Q% of the month at which time I will notify you so an inspector can come out. I also wish to remind you that you said we would NOT be assessed the $300.00 if we could expedite the work. Thank you very much for your assistance in this matter - I will call you soon. Sincerely, Marlene E. Milinkovich 5605 West Bavarian Pass r dley, MN 55432 SusjECT PERMIT NO. City of Fridley P, ?4'148 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • _____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. iii777 /f 0-� i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/7/96 JOB ADDRESS See Below 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Variou SHEET I 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Various 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Columbus Exteriors - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Townhouses 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside 9 CHANGEOFUSEFROM TO STIPULATIONS 5600,5602,5604,5606 West Ba /V-..,."an Pass; 5601,5603,5605,5607 West Bavarian Pass; 5610,5612,5614,5616 $ewe#eye-Pees; 5620,5622,5624,5626 West Bavarian Pass; 5620,5622,5624,5626 North Innsbruck Ct; 1521,1523,1525,1527 Trapp Court; 5650,5652,5654,5656 West Bavarian Pass; 5660,5662,5664,5666 West Bavarian Pass; 5661,5653,5655,5657 West Bavarian Pass; 5671,5673,5675,5677 West Bavarian Pass; and 5681,5683,5685,5687 West Bavarian Pass SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST, OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 44 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $114.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $228,800 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $1,532.25 Fire SC $228.80' STRUCTION R THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE G License SC $5.00 $1,880.45 SSG OF CONTRACTOR OR AUTHORIZED AGENT IDATEi WHEN PROPERLY IDATED THIS IS YOUR PERMIT I r BLDG SP ()Alt S.GNATURE OF OWNER„F OWNER BUILDER, ,DATE' SUBJECT NO. City of Fridley 7�MIFT 2 617 4 AT THE TOP OF THE TWINS BUILDING Ni i T t° ECEIPT NO. , COMMUNITY DEVELOPMENT DIV. L v �912,3 r 1 PROTECTIVE INSPECTION SEC. e , r , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 "j 612-571-3450 910415 6/9/98 JOB ADDRESS 5605 West Bavarian Pass NE i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 22 Innsbruck Villages SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Michael Milinkovich 5605 West Bavarian Pass NE 571-4466 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct an 18' x 16' Detached Front Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Before r"Wlcg call fm all ut�NIIV locat om 454-c0,12 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,143 $1.67 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 Fire SC $2.14 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $77.96 SIGNATURE IDATEI EOOgF_CONTRACTOR ORRAUTHORIZED AGENT q/ WHENjPROPERL ALIDATED THIS IS YZR PERMIT BLEA INSP pAT SIGNATURE OF OWNER IIF OWNER BUILOERI IDATEI NEW [ ] Effective 1/1/98 ADDN 44 CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1� BUILDING PERMIT APPLICATION ConstructionAddress:��/ ® �1� �3;41/ .7!5 Legal Description: LO j y Owner Name & Address: L�(�?c�li i Tel. # Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il"ROVEMENT LIVING AREA: Length Width AO Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA:�J � r� � Length Width Hgt/Ground 2 / Sq. Ft. Zs ly? 9-I OTHER: �� p h� 1 , %13,13 Construction Type: Estimated Cost: $ _0 LLD (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: � 3 APPLICANT: ��/%��� - — Tel. # CITY USE ONLY Permit Fee $ �f �/, �9' Fee Schedule on Reverse Side Fire Surcharge $ % .001 of Permit Valuation (1/10th%) State Surcharge $ 1,07 $.501$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee a $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 9 STIPULATIONS: Top View of Your Deck The Scale is 1/4" : 1' nae go;, jvov,x UZAI� P /- 6/x,6. sAh Lie zd!!�.-12 V z --- tin tnQm6,,- .�P11-1- 11 H S 010f fi(4 City of Fridley SUBJECT IT .- T_;9 AT THE TOP OF THE TWINS II III L D I N PERMITs5�V0 r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ___ __ I b - PROTECTIVE INSPECTION SEC r , , NUMBER REV DATE PAGE OF <APPROYED BY _ CITY MALL FRIOLEV 55132 763-571-3450 910-F1-5 10 16103 JOB ADDRESS 5605 West Bavarian Pass NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mike Miliknovich 5605 West Bavarian Pass NE 763-571-4466 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO RMA Home Services Inc 3200 Cobb Galleria Pkwy STE #200, Atlanta, GA 30339 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 763-542-8826 20268257 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Replace two windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,678 @ $.84 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $60.10 Fire SC $1.68 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Licenj SC $5.00 $67.62 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI H N PROPERLY G INSo VALIDATED THIS IS YOR PERMIT 0 gAtE S,GNATURE OF OwNEROf OWNER BUILDERI IDATEI NEW[ ] Effective 5/10/99 ADDN [ l CITY OF FRIDLEY ALTER [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: QO1j Legal Description: Owner Name & Address: H 1 LL K= ch Tel. #7yi -J-7 Contractor; RMA HOME SERVICES INC. MN LICENSE # Home Depot Installed Sales Address: 3200 Cobb Galleria Pkwy., Ste. #200 Tel. # Atlanta, GA 30339 A 763-542-8826 urvey bf the 1(_ C-20268257 r---�-� �.v._ in -it to scale. DESCRW-PO 10)? LW- 1A0VEMEPPr LIVING AREA: Length Wirth Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width* Hgt/Ground Sq. Ft. OTHER: P Gr -f 111-fLOAZ�, In///Y7 PY t % Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ , (Q-7 8, oQ Ft x $_ = $ DATE: APPLICANT: Tel. # 9S�• 3 y.5'• (��-7 T Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ STIPULATIONS: CITY j USE ONLY Fee Schedule on Reverse Side .001 of Peomit Valuation (1/10th%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determijned by Engineering Agreement Necessary [ ] Not Necessary [ J CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 :57Z -36U4 VAN: (763) 571-1287 ADDRESS : 5605 W BAVARIAN PASS NE PIN : 243024410237 LEGAL DESC : INNSBRUCK VILLAGES : LOT 4 BLOCK 22 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : TOWNHOUSES CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00924 �30t DATE ISSUED: 06/17/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR CONDITIONER. # INSPECTIONS 1 # 0-100 AMP CIRCUITS 0 # 101+ AMP CIRCUITS 0 APPLICANT SPARK ELECTRIC 2114 WASHINGTON ST NE MINNEAPOLIS, MN 55418 - OWNER MILINKOVICH MICHAEL C & M E 5605 W BAVARIAN PASS NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date, ELEC CIRCUIT FEE (0-100 AMPS) 0.00 ELEC CIRCUIT FEE (101+.AMPS) 0.00 ELEC PERMIT FEE - MAX (RESI) 0.00 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 39905 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMITO.: 2004-009982 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/24/2004 763) 572-3604 FAX: (763) 571-1287 ADDRESS 5605 W BAVARIAN PASS NE PIN 243024410237 LEGAL DESC INNSBRUCK VILLAGES LOT 4 BLOCK 22 PERMIT TYPE HEATING PROPERTY TYPE : TOWNHOUSES CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 5,509.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, BRYANT, 66,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES 1 # GAS DRYERS APPLICANT STANDARD HEATING & AIR COND CO 410 WEST LAKE ST NIINNEAPOLIS, MN 55408-2998 (612) 824-2656 3A j 0 MILINKOVICH MICHAEL C & M E 5605 W BAVARIAN PASS NE FRIDLEY, MN 55432 0 # GAS RANGES 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating cgnnstruction or the performance of construction. Bldg Insp FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 60.50 PAID WITH CHECK # 10699 Y SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431t University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 1e bq %5 - Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CC Fee Total $35.00 $25i--00 $10.00 $ $10.00 $ $10.00 $ $25.00 $ a S . `90 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR JOB Own Building Used As (% !S f C"ce� ESTIMATED C-ST—S5Cq—_PERMIT NO �QO V -0096o) DESCRIPTION OF FURNACE AND BURNER # of Heating Units_ Circle One (Steam) (Hot Water) ( arm`Ai Trade Name 4 Size No. y BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes $ and rulings of the Building Division, and hereby declares that all the facts $ J50 $Ip --50 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE and representations stated in this application are true and correct. STANDARD HEATING & AIR CONDITIONING CO. HEATING CO 410 WEST LAKE STREET MINNEAPOLIS, MN 55408-2995 Si n 612 - FAX # .a— to " 3 Date Approved by Rough -in Date Final Date 3 FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (c� No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer 4-No( specifications including sizing, length, number of elbows and termination. Yes() ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (ely/ No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes (Y.}� No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (J� No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (0// No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input ®0-0 Fan Assisted or Nat ie9-- Appliance #2 Type tN BTU Input Fan Assisted or Nat�� Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _� Total Btu InputD C) o Common Vent Type S Vent Height %� Diameter inches Appliance #1 Vent Connector Height . S ft Length 9 ft Diameter `7" in Type Appliance #2 Vent Connector Height / L !S' ft Length !S;-- ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: Describe &- ?� HEATING CO: Signed By: Date Building PLUMBING PennitNo.-2-00&—QAM,2 Inspections RESIDENTIAL APPLICATION Received By: -7 763-572-3604CITY OF FlZIDLEY Date Ree'd: /Z �7 l' DATE �� S YOUR E-MAIL ADDRESS ® 0- �1 IM �s Lc��l SITE ADDRESS OS e-0-yx 0. �' THIS APPLICANT IS: )A OWNER DCONTRACTOR PROPERTY NAME: OWNER/ ��'��^, ADDRESS: ��X/ Vali"r CITY J'� tet, STATE,ZIP TENANT PHONE: e' l Z. ` SOS - 'RS 4 7 - CONTRACTOR NAME: 44- STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE FAX APPLICATION PERNM TYPE D SINGLE FAMILY O TWO FAMILY XTOWNHOUSE TYPE OF WORK: D NEW )f'tEPLACEMENT DETAILED DESCRIPTION OF WORK 1_�e, 0-e- LO°'ie"f- vee v'R5 ( V -.CG C'k ove- PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for e improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS —SHOWER _ WATER PIPING _ _FLOOR PIPING aaw c=ucm" _ SWIMMING POOL —WATER SOFTNER ($35) —BATHTUB —GAS CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _BACKFLOW PREV. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER m.WMr Permit Fee $. a® Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ `a _. d Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of 1 work w ich requires review and approval of plans. ii j i Kauc� `-1/lAtl'C DATE Z Z7 0:5- SIGNATURE OF APPLICANTPeQ��PRINTNAI'vlE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 /A e. ) Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd:U K DATE _ 1a YO E-MAIL ADDRESS S SITEADDRESS 15ayac 0 ox -N SULJ THIS APPLICANT IS: O OWNER CONTRACTOR PROPERTY NAME: XaAkA 1�Mq-t0ninik-1- ADDRESS: CITY STAT1�_kkIP�' - OWNER/ TENANT o_r�® PHONE: CONTRACTOR NAME: STATE LICENSE # '541 EXP DATE SUBMIT A COPY OF s' rr STATEJ4 LIP 5ja!) Q DQdd RdCITY S CLC IJ YOUR STATE ADDRESS: LICENSE WITH PHONE - �(g2" J' I-' FAX APPLICATION PERMIT TYPE u�RINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: ❑ NEW PLACEMENT DETAILED DESCRIPTION OF WORK � PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINKILAV DRAINS _ SHOWER _ WATER PIPING _ _FLOOR GAS PIPING (tEw cm'ucFYA _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _BACKFLOW PREV. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ _ WATER METER —OTHER ,PEIZMIT FF✓E:'PROJEO`�'�� �} _ >'� .,#� ��' �: ���,x,��g�,�;xtw����5",� � "� 'f��`� ��°�' ��� �����' Number of fixtures @ $10.00 x $10.00 = $ Permit Fee $ 5 ou _ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of allw r which equines review and approval of planj. Q SIGNATURE OF APPLICANT PRINT NAME W 15 0 1 6yN DATE PIBAS I City of Fridley Building Inspections Department. 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �� 5�